[Iodine deficiency in the world and in the Czech Republic--current status and perspectives]. / Jodový deficit ve svete i v Ceské Republice--soucasný stav a perspektivy.

Iodopenia is importance world-wide problem--the cause of spectrum of iodine deficiency disorders (IDD). The "simple" way for its compensation is iodine supplementation--preferably by iodinization of salt: in the Czech Republic prevalence of IDD was very high in the past. The complex program for compensation of iodine deficiency realized in the CR includes improvement of salt iodization, supplementation of pregnant and lactating women, fortification of products for babies' nutrition and increasing use of iodinized salt in general population incl. food industry. Thus CR is country with compensated iodine deficiency according to criteria WHO, UNICEF, ICCIDD. In future, however, systematic interest should be focused on optimalization of iodine saturation, esp. in pregnant women and evaluation of possible risk of supranormal iodine intake (impairment of thyroid function, activation of thyroid autoimmunity). Taking in account, the changes of nutrition and life style systematic monitoring of quality of iodine supplementation seems to be essential.

[Evaluation of results of iodine prophylaxis in Czech Republic]. / Hodnocení výsledku jodové profylaxe v ceské republice.

BACKGROUND: Improvement of system of iodine prophylaxis in Czech Republic resulted in compensation of iodine deficiency. Effects of increased iodine intake on the status of thyroid gland (volume, function, autoimmune disorders) should be determined. The aim of the study was to evaluate those effects in an epidemiological survey. METHODS AND RESULTS: A randomly selected sample of adult population (18-65 years old) from 3 regions was investigated using the same methods at the interval of 5 years. A significant increase of ioduria was proved with the marked increase of prevalence of high category (over 300 ug of I per 100 mL of urine). Volume of the thyroid gland decreased significantly in women, not in men. No significant changes of TSH were observed, however FT4 level slightly, but significantly increased. CONCLUSIONS: Repeated epidemiological survey of the randomly selected sample of adult population in 3 regions verified the effectiveness of improved iodine prophylaxis with not unequivocally positive increase of high (supraphysiological) category of ioduria. Decrease of thyroid volume was proved in women only, a tendency of mild (clinically not important) increase of thyroid function was also observed.

[Selenium deficiency of west Bohemia population]. / Deficit selenu v populaci západních Cech.

To estimate status and intake of selenium in inhabitants of the most Western region of the Czech Republic (Cheb region) 241 serum, 404 urine and 30 hair samples from randomly selected persons in the age between 6 and 65 years is performed. Serum and hair samples were analysed by means of instrumental neutron activation analysis (INAA), while Se in urines was detected by means of fluorimetry. Urine iodine was determined in the same group by Sandell-Kolthoff method for the possibility to detect concomitant Se and I deficiency and/or correlations between these two essential trace elements necessary for metabolism of thyroid hormones. Average values of Se indexes are low (55.4 +/- 13.8 microg Se/L serum; 15.4 +/- 5.7 microg Se/L urine; 13.6 +/- 6.0 microg Se/g creatinine; 0.268 +/- 0.051 microg Se/g hair) and prove Se deficiency in the searched population. Statistical evaluation of Se in subgroups of boys, girls, men and women proved significant differences as far as age is concerned, gender differences were found only between boys and girls. Some significant and highly significant differences were found also in subgroups according age and gender (males and females in the age of 6, 10, 13, 18-35, 36-49 and 50-65 years). On the other hand, urine iodine average value (126 +/- 65 microg/L) is on the lower optimum level. By the use of correlation analysis, slight but significant correlations were found between Se and I in urine and some of thyroid hormone parameters and their influence on the organism.

International study in premedical education.

This study surveyed medical school admission deans about the desirability of international study. Most agreed that an international study program in the premedical years was beneficial, but most were neutral concerning science courses taken in international programs.

[The status of soil contamination in areas of northern and northwestern Bohemia affected by pollution]. / Stav kontaminace pud v imisne zatízených regionech severních a severozápadních Cech.

A regional study of soil contamination in North and Northwest immission-impacted Bohemian regions present the results of the assessment of soil loads of agricultural soils by hazardous trace elements and organic xenobiotic substances. The evaluation is based on the exceeding of background values of contaminants (upper limit of their variability). Two forms of soil loads by trace elements are differentiated, the anthropogenic and geogenic one. They occur simultaneously on the territory under study. Geogenic "loads" prevail (basalts, metallogenic zones). Anthropogenic contamination by both hazardous elements and organic xenobiotic substances occurs only in some parts of these severely immission-impacted regions.

[Soil contamination with persistent trace substances in relation to the body]. / Kontaminace pud perzistentními stopovými látkami ve vztahu k organismum.

The assessment of soil contamination by persistent substances is based on a multi-level system of criteria of contents, mobilities and transfer of hazardous trace elements into organisms and of contents and behaviour of organic xenobiotic substances, which reflects the increasing risks. The basis of the assessment are background values of contaminants, which represent the upper limit of the variability of natural and anthropogenic diffuse contents. The development of the eco-, zoo- and humanotoxicologically relevant criteria is supported by risk assessments, which are additionally performed to verify the on-site risk after the limits have been surpassed. Cooperation is needed among toxicologists of human and veterinary medicine, sanation specialists and soil scientists.

Oxidation and amidation of salicylate by Streptomyces species.

Seven streptomycete strains were tested for biotransformation of salicylate. The products were identified by nuclear magnetic resonance spectroscopy and three types of conversion were found. Streptomyces cinnamonensis and Streptomyces spectabilis formed gentisate and salicylamide concurrently. Streptomyces rimosus transformed salicylate to salicylamide. Streptomyces lividans, Streptomyces coelicolor, Streptomyces griseus and Streptomyces avermitilis produced only gentisate. Time course studies of salicylate conversion by thin-layer chromatography and high pressure liquid chromatography showed that salicylamide was accumulated in the culture broth, whereas gentisate was further metabolized.Key words: salicylate, gentisate, salicylamide, biotransformation, Streptomyces spp.

HLA typing in women with breast implants.

Since the 1970s, anecdotal reports have described a relatively small number of women who received silicone gel breast implants and later developed either a recognized rheumatologic disease or unexplained symptoms suggestive of an autoimmune disorder. The study reported here examined whether there is any association between the symptoms seen in implant patients and HLA molecules. One-hundred and ninety-nine subjects were evaluated by HLA typing: symptomatic patients with implants (group I, n = 77), asymptomatic women with implants (group II, n = 37), healthy female volunteers without implants (group III, n = 54), and fibromyalgia patients without implants (group IV, n = 31). A statistically significant 68 percent of group I were positive for HLA-DR53, compared with 35 percent of group II and 52 percent of group III. The fibromyalgia patients were strikingly similar to group I women in terms of HLA-DR molecules, with 65 percent of group IV being positive for DR53. Group I also had a statistically significant increased frequency of HLA-DQ2. Asymptomatic women with implants (group II) had an increased frequency of DR1 and DQ1. In addition, 42 percent of symptomatic patients with implants formed autoantibodies to their own B cells; of these, 81 percent were DR53-positive. Although frequencies of capsular contracture and implant rupture were not significantly different in the two groups with implants, there were statistically significant associations in group I between contractures and ruptures and the presence of DR53 and B-cell autoantibodies. These data suggest that symptomatic patients with implants share important genetic characteristics (primarily HLA-DR53 positivity) that differentiate them from their asymptomatic counterparts. DR53 may be a marker of women who are predisposed by their HLA genotype to develop symptoms following exposure to silicone gel breast implants.

Retrospective monitoring and inventory of soil contamination in relation to systematic monitoring.

Retrospective monitoring of soil contamination has been performed in the Czech Republic. This kind of monitoring is based on the comparison of the heavy metals content in soil samples taken during a systematic soil survey (1960-1970) and in samples taken at the present time. The anticipated high degree of soil pollution in the Czech Republic has not been proved. Most of the contaminated soils were found to be loaded just 20-35 years ago. Retrospective monitoring is considered to be an accelerating tool for determining the strategy of the systematic monitoring of soil contamination. This procedure stimulated the development of the multi-step system of soil loading limits.

The efficacy of breast augmentation: breast size increase, patient satisfaction, and psychological effects.

In this study designed to quantify the degree of breast enlargement produced by augmentation mammaplasty, 112 women who underwent breast augmentation were interviewed. The size increase that typically resulted from various implant volumes was measured by comparing preoperative and postoperative bra sizes. For the study group as a whole, the average increase was two bra sizes (either increased cup size or a combination of increased cup size and chest circumference), regardless of the implant volume inserted. Patients also were asked a series of questions to evaluate the impact of the surgery on various psychological parameters, including body image, feelings of self-confidence, and interpersonal relationships. Along with having a very positive body image, the group reported decreased self-consciousness (86 percent) and heightened self-confidence (88 percent); in addition, 95 percent said they felt better about themselves after surgery. The women's satisfaction with the results of augmentation and the success of surgery in meeting their expectations also were measured. Eighty-six percent reported being completely or mostly satisfied with the postoperative results, 86 percent felt the operation was a complete success, and 95 percent said that augmentation met their expectations.

Diagnosis and treatment of accessory parotid gland masses.

Accessory parotid glands are true parotid tissue lying distinctly separate from the parotid gland proper. They lie along and drain into Stensen's duct. Although literature describing the accessory parotid gland is limited, its anatomy and pathology have been described. Controversies exist in the literature regarding the diagnosis and management of pathological changes seen in these glands. We have found magnetic resonance imaging to be extremely helpful in their diagnosis and treatment. A review of the literature and an illustrative example are presented.

How safe are silicone breast implants?

The Food and Drug Administration's recent decision to limit the use of silicone gel breast implants was surrounded by a great deal of misleading information in the popular press. This article outlines the most relevant information available in the literature on the most often raised safety issues, including the carcinogenicity of silicone, speculation on a possible connection between silicone and autoimmune disease, the significance of gel bleed, and the effect of implants on mammography. In this attempt to better educate primary care physicians, we explain what is known about silicone gel breast implants so physicians can more wisely counsel their patients, who may be needlessly frightened by inaccuracies they have heard.

Indications for prophylactic mastectomy.

This article reviews the current state of knowledge regarding factors which put women at highest risk for developing breast cancer and identifies that population we consider as potential candidates for prophylactic mastectomy. Specifically, we focus on the concept of cumulative predisposition and the relative risk assigned to more significant factors that increase a woman's chances of developing breast cancer: family history, proliferative breast histology, and previous cancer in one breast. In addition to outlining the results of reconstruction, the article also examines the controversy surrounding the issue of whether any mastectomy can be truly prophylactic. We conclude with advice to physicians who must counsel women concerned about their breast cancer risk so they can help their patients make fully informed choices.

Quantitative three-dimensional assessment of face-lift with an optical facial surface scanner.

Three-dimensional computed tomographic scan images of facial deformities provide information that has been useful in planning and evaluating therapy. However, the benefits of computed tomographic imaging in cosmetic plastic surgery are often insufficient to justify exposing the patient to radiation. This report describes application of an optical, noncontact, three-dimensional surface digitizer with subsecond scanning time for 360-degree examination of the human head. The resultant three-dimensional surface data are suitable for computer graphics display and manipulation, and for noncontact skin surface measurement. The scanner provides accurate and complete coverage of complex facial surfaces. This system was applied to digitization of the human head in the planning and evaluation of facial plastic surgery. The results indicate that the resulting image is accurate enough to detect subtle dimensional changes resulting from surgery, including postoperative edema and surface changes due to face-lift. This type of scanning can assist in a number of tasks performed by plastic surgeons, including collecting anthropomorphic measurements, preoperative and postoperative assessment, volume monitoring, customizing of implants, and interactive planning.

Screening mammography in 350 women with breast implants: prevalence and findings of implant complications.

OBJECTIVE: A series of screening mammograms in asymptomatic women with breast implants was reviewed to determine the prevalence of clinically silent sequelae of breast augmentation and to analyze the mammographic findings. MATERIALS AND METHODS: The screening mammograms of 350 consecutive women with implants were reviewed retrospectively by experienced mammographers. Any women who reported problems had a diagnostic examination and therefore were not included in our sample. Mammographic features of sequelae specific to implantation such as development of a fibrous capsule, periprosthetic calcification, implant herniation, and silicone leaks were tabulated. Additionally, modified compression (push-back) views, when obtained, were evaluated for their usefulness. RESULTS: Fibrous encapsulation of breast implants was seen in 257 (73%) of 350 women. Periprosthetic calcification was seen in 90 (26%), and 60 women (17%) had implant herniations. Sixteen women (5%) had implant failure as evidenced by silicone leak. Two of these women had bilateral implant failures. Surgical confirmation was attainable in only five of 16 women. Analysis of modified compression views demonstrated an overall improvement in visualization of breast tissue with this technique. Although the sample size is small, there was a significant increase in the amount of breast tissue seen with push-back views in women with submuscular implants. CONCLUSION: Our analysis revealed a wide range of mammographic findings in this group of asymptomatic women with breast augmentation. Especially worrisome is the 5% prevalence of unsuspected silicone extravasation. Additionally, we have demonstrated the usefulness of push-back views in this screening group, especially in women with submuscular implants.

Advances in total phalloplasty and urethroplasty with microvascular free flaps.

This article focuses on the lateral arm free flap as the option that comes closest to meeting the diverse aesthetic and functional goals of phalloplasty. The authors introduce a new technique for incorporating a prefabricated neourethra within the lateral arm to permit the coexistence of an erectile prosthesis alongside a fully vascularized urethra that extends to the distal tip. The unrecognized value of the radial forearm free flap for urethroplasty is also discussed and a case of reconstruction following urethral loss is presented. Also described is how the prefabricated urethra technique may be useful for repairing severe hypospadias defects.

Cumulative trauma disorders: An overview of the problem.

Cumulative trauma disorders-which result from highly-repetitive job activities, sustained loads, and exposure to vibratory forces-are rapidly spreading through the industrialized world. As their prevalence increases, so do the economic and social consequences. This paper provides an overview of the problem to illustrate the fact that addressing the rising incidence of CTDs requires a multidisciplinary approach involving research and programmatic efforts directed on many fronts, most notably medicine, engineering, management, occupational health, and government. After a review of the diagnosis and treatment of cumulative trauma disorders is presented, the importance of ergonomic analysis for identifying workers at risk is discussed. Some prevention strategies currently being implemented in workplaces around the country are also described. Finally, we raise important industry and public policy issues which need to be confronted if the incidence of CTDs is to be reduced and costs of the workers' compensation system contained.